Autism has many presentations around the world. From top left: an autistic toddler stacking cans; an autisticfigure skater competitor; a child using anabacus at school run by Autism Somalia Center; bankerDonald Triplett, the first person to be diagnosed with autism.
Based on a combination of clinical observation of behavior and development and comprehensive diagnostic testing completed by a team of qualified professionals. For adults, the use of a patient's written and oral history of autistic traits becomes more important
Autism, also known asautism spectrum disorder (ASD),[a] is a condition characterized by differences or difficulties in social communication and interaction, a need or strong preference for predictability and routine, sensory processing differences,focused interests, or repetitive behaviors.[4] Features of autism are present from early childhood and the condition typically persists throughout life.[5][6] Autism is classified as aneurodevelopmental disorder,[7] and aformal diagnosis requires professional assessment that these characteristics cause significant challenges in daily life beyond what is expected given a person's age andsocial environment.[8][9][10][11] Because autism is aspectrum disorder, presentations vary and support needs range from minimal to the person beingnon-speaking or needing 24-hour care.[12][8][9][13]
There is no cure for autism.[27] Severalautism therapies aim to improve self-care, social, and language skills.[28] Reducing environmental and social barriers helps autistic people participate more fully ineducation,employment, and other aspects of life.[29][30][31] No medication addresses the core features of autism, but some are used to help manage commonlyco-occurring conditions, such as anxiety, depression, irritability, ADHD, and epilepsy.[32][33]
The idea of autism as a disorder has been challenged by theneurodiversity framework, which frames autistic traits as a healthy variation of the human condition.[34] This perspective, promoted by theautism rights movement, has attracted increasing research attention,[35] but is debated and remains controversial among autistic people, advocacy groups, healthcare providers, and charities.[36][37]
Signs and characteristics
Autism is primarily characterized by differences and difficulties in social interaction and communication, alongside restricted or repetitive patterns of interests, activities, or behaviors (stimming), and, in many cases, distinctive reactions to sensory input. The specific presentation varies widely.[38][39] Clinicians often consider assessment for autism when these characteristics are present, especially if they are associated with difficulty obtaining or sustaining employment or education, difficulty initiating or maintaining social relationships, involvement with mental health or learning disability services, or a history of neurodevelopmental conditions (including learning disabilities andADHD) or mental health conditions.[40][41] In most cases, signs of autism are first observable in infancy or early childhood and remain throughout life.[42] Autistic people may be significantly disabled in some respects, but average—or, in some cases,superior—in others.[43][44][45]
Social and communication skills
Autistic people may have differences in social communication and interaction, which can lead to challenges in environments structured around non-autistic norms. Current diagnostic criteria for autism require difficulties across three social domains: social-emotional reciprocity, nonverbal communication, and developing and maintaining relationships.[1]
Social–emotional reciprocity
Common early signs of autism include little or nobabbling in infancy.[38] Difficulties may also be apparent in traditional forms of reciprocal social interaction, such as games likepeek-a-boo[38] orpat-a-cake,[46] as well as in shared attention to objects of interest.[38] Historically, autistic children were said to be delayed in developing atheory of mind, and theempathizing–systemizing theory proposed that while autistic people may have compassion (affective empathy) for others with similar autistic traits, they often have limited, though not necessarily absent,cognitive empathy.[47] This may present as social naïvety,[48] lower-than-average intuitive perception of the meaning or utility ofbody language, social reciprocity,[49] or social expectations, including thehabitus,social cues, and certain aspects of sarcasm,[50] which to some degree may be influenced by co-occurringalexithymia.[51]
Recent research has increasingly questioned these earlier interpretations,[52] as thedouble empathy problem theory (2012) proposes that misunderstandings arise mutually between autistic and non-autistic people, rather than solely from autistic deficits in empathy or social cognition.[53][54] This perspective has contributed to a growing recognition that autistic behavior and communication may reflect different, rather than deficient, social behavior and communication styles.[52][54] Autistic interests and conversational styles are often characterized by a strong focus on specific topics, a phenomenon known asmonotropism.[55][56]
Nonverbal communication
Autistic people often display atypical behaviors or differences innonverbal communication. Some may make infrequenteye contact, even when called by name, or avoid it altogether because they find it uncomfortable, distracting, or overstimulating.[57] They may recognize fewer emotions or interpret facial expressions differently, and may not respond with expressions expected by their non-autistic peers.[58][59] They can also have difficulty inferring social context or subtext in conversation or text, resulting in different interpretations of meaning.[60] Speech characteristics such as volume, rhythm, and intonation (prosody) can vary,[61] and atypical prosody is estimated to occur in at least half of autistic children.[61]
Developing and sustaining relationships
Signs of autism in childhood include less apparent interest in other children or caregivers, possibly with more interest in objects.[38] Behaviors that may appear as indifference to non-autistic people often reflect autistic differences in recognizing others' personalities, perspectives, and interests.[60] Most research has focused on interpersonal relationship difficulties between autistic and non-autistic people and on teaching social skills to address these gaps. But newer studies indicate that autistic people often form satisfying relationships with other autistic people, which can enhance quality of life.[62]
Children on the autism spectrum are more likely than their non-autistic peers to be involved inbullying, most often as victims.[63] Among autistic people who seek friendships, reduced friendship quantity and quality are often associated with increased loneliness.[64] Autistic people also face greater challenges in developing romantic relationships than non-autistic people.[65]
Over time, many autistic people learn to observe and form models of social patterns, and develop coping strategies, such as "masking".[66] Masking is associated with poorer mental health outcomes as well as delayed diagnosis, which can limit access to appropriate supports.[66]
Restricted and repetitive behaviors
A young autistic boy who has arranged his toys in a row
The second core feature of autism is a pattern of restricted and repetitive behaviors, activities, and interests. To be diagnosed with autism under the DSM-5-TR, a person must exhibit at least two of the following behaviors:[1][67]
Repetitive behaviors: actions such as rocking, hand flapping, finger flicking, head banging, or repeating phrases or sounds (includingecholalia[46]).[68] These behaviors may occur consistently or primarily when the person is stressed, anxious, or upset. They are also known asstimming. Other examples include playing with toys in ways others might consider limited or unusual[38] (e.g., arranging toys in a row[46]).
Resistance to change: a strong preference for routine, such as performing daily tasks in a specific order or showing distress in response to changes others may consider minor.[69] The person may become distressed if their routine changes or is disrupted.[69]
Focused interests: intense interest in a particular activity, topic, or hobby, often accompanied by sustained attention and deep knowledge; for example, a strong attachment to certain objects[1] or frequent discussion of a specific topic.[70]
Sensory reactivity: atypical responses to certain sensory inputs, such as aversion to specific sounds or textures, fascination with lights or movement, or apparent indifference to pain or temperature.[71]
It is increasingly argued that these characteristics should be accepted, which is supported by their recognized functions, such as self-regulation.[72] Focused interests can also provide personal fulfillment and contribute to the development of specialized knowledge.[70] A distinction should be made between these features and those ofobsessive–compulsive disorder, which can co-occur with autism and involve compulsions or obsessions aimed at preventing feared outcomes.[73]
Spoken communication skills
Differences in verbal communication often become noticeable in early childhood, as many autistic children develop language skills at an uneven pace. Speech may emerge later than is typical or not at all (non-speaking autism), while reading ability may be present before school age (hyperlexia).[59] Reducedjoint attention may distinguish autistic from non-autistic infants.[74] Infants may show delayed onset of babbling, atypical gestures, lower responsiveness, or vocal patterns that are less synchronized with caregivers. During the second and third years, autistic children may produce less frequent and less varied babbling, consonants, words, and word combinations, and may integrate gestures with speech less often. They are less likely to make requests or share experiences, and more likely to repeat others' words or phrases (echolalia).[75] About 25–35% of autistic school-age children are non-speaking or minimally speaking.[76] The age at which speech develops and the complexity of early language development are significant predictors of verbal communication abilities in later life.[76]
Self-injury
Self-harm occurs about three times more often in autistic people than in non-autistic people.[77] Behaviors can include head-banging, hand-biting, and skin-picking, and can lead to serious injury or, in rare cases, death.[78] Several explanations have been proposed for why self-harm develops and persists among people with developmental conditions such as autism.[79] Communication difficulties may lead some autistic people to use self-injury to express needs, distress, or other messages.[78] Self-harm may also help regulate sensory input[80] or modulate pain perception, particularly for those experiencing chronic discomfort or medical conditions.[79] Neurological factors are also under investigation, with atypicalbasal ganglia connectivity suggested as a potential biological predisposition in some autistic people.[79]
Wandering (elopement)
Some autistic people "wander" off – a behavior known aselopement – and place themselves in danger. About half of families with autistic children report elopement.[81] The propensity for elopement increases with the severity of the autism.[81] Siblings unaffected by autism show much lower rates of elopement.[81]Drowning, a leading cause of death for autistic children,[82] andtraffic injuries are among the dangers associated with elopement.[81]
Fatigue, burnout, inertia, meltdown, shutdown
Several non-diagnostic models have been used to describe challenges that autistic people face in their daily lives.[83] These concepts lack formal clinical criteria, but are widely described by autistic people themselves.[83][84]
Autistic fatigue or burnout is a prolonged state of mental and physical exhaustion.[85][84][83][86] It is described as distinct from, but similar to,occupational burnout, and is often linked to the pressure to camouflage or mask autistic traits in social interactions.[84][85] The term "autistic burnout" was first used in 2008, with research into the phenomenon undertaken in the 2020s.[85] Several researchers have proposed various characterizations of autistic burnout, but no consensus definition exists.Depression can be misattributed to autistic burnout, as they have several overlapping criteria. Reported coping strategies include reduced masking, increased stimming, engaging in special interests and familiar activities, and seeking stress relief. Some affected people temporarily withdraw from social contact as a recovery strategy; while providing relief, interpersonal withdrawal can also result in loneliness and worsening mental health. There is limited data on professional interventions.[85]
Autistic inertia is a difficulty experienced among autistic people with initiating, transitioning between, or stopping activities or mental states.[84] It may manifest as a feeling of being "stuck", where people find it challenging to begin a task, shift focus to a different activity, or disengage from an action, even when they want to.[83]
A meltdown may occur if, upon processing large amounts of information, an autistic person experiences anxiety or feels overwhelmed.[87] Triggers may besensory or social, and often include unpredictability, unmet basic needs, and emotional situations, which tend to accumulate.[87] A meltdown can be expressed audibly (e.g., screaming or crying) or physically.[87] The person often shows signs of distress beforehand, such as pacing, asking repetitive questions, trembling, or sweating.[87] An autistic shutdown is similar, but inward, and the autistic person is often unable to speak or withdraws completely.[87] Meltdowns or shutdowns may be prevented by eliminating the distressing factors.[87] They may be ameliorated by avoiding further questions or pressure, showing the person that one is there to help, and allowing the person to calm down by leaving the situation or breathing slowly.[87]
Cognitive profile
Autistic people often show an uneven or "spiky" cognitive profile, with relative strengths in some cognitive domains alongside difficulties in others.[88]The otherwise raresavant syndrome, characterized by an isolated skill in a narrow area, is more common among autistic people, but studies of its prevalence have found different results. These special skills are related to prodigious memory. Most common are splinter skills, such as memorization of sports trivia or historical facts.[89][90]Research has also reported enhanced performance by autistic participants on certain perceptual and attentional tasks.[91]
Other features
Autistic people may exhibit traits or characteristics that are not part of the formal diagnostic criteria but can nonetheless affect their personal well-being or family dynamics.[92]
Unusual or atypical eating behavior occurs in about 70% of children on the autism spectrum,[97] to the extent that it was once considered a diagnostic indicator.[92] Selectivity is the most common characteristic, although eating rituals and food refusal are also reported.[97]
The exact causes of autism are unknown,[99][100][101][102] with genetics likely being the largest contributing factor. It was long presumed a single cause at the genetic, cognitive, and neural levels underpinned the social and non-social features,[103] but autism is increasingly thought to be a complex condition with distinct, often co-occurring, causes for its core aspects.[103][104] It is unlikely that autism has a single cause;[104] research has identified many factors as potential contributors,[105] including genetics,[67]prenatal and perinatal (shortly after birth) history,[105]neuroanatomical anomalies, changing social demands in the workplace or in school,[14] and environmental influences.[105] It is possible to identify general factors but difficult to determine specific ones.[106] Research into causes is complex due to challenges in identifying distinct biological subgroups in the autistic population.[107]
Hundreds of different genes are implicated in the likelihood of being autistic, most of which influence the brain structure in a similar way.
Autism has a strong genetic basis, but thegenetics of autism are complex and it is unclear whether autism is explained more by raremutations with major effects or by rare multi-gene interactions of common genetic variants.[108][109] Twin studies indicate that autism is highly heritable, with genetic factors explaining most of the risk and shared environmental effects playing a minor role.[17] Numerous genes have been found to be associated with autism, with most loci individually explaining less than 1% of autism cases[110] and having only small effects.[108] While these genetic variants are associated with a higher likelihood of being autistic, they do not individually determine whether someone will be autistic.[111] Complexity arises from interactions among multiple genes, the environment, and heritableepigenetic factors (which influencegene expression without changingDNA sequence).[112]
Typically, autism is not traceable to a single-gene (Mendelian) mutation orchromosome anomaly, and no known genetic syndrome selectively causes autism.[108] If autism is one characteristic of a broader medical condition, such asfragile X syndrome, it is calledsyndromic autism, as opposed to non-syndromic or idiopathic autism, which is typically polygenic without a known cause.[113] Syndromic autism is present in approximately 25% of autistic people.[114] Research has suggested that autistic people with intellectual disability tend to have rarer, more impactful, genetic mutations than those found in people diagnosed solely with autism.[115] A number of genetic syndromes causing intellectual disability may also co-occur with autism, includingfragile X,Down,Prader–Willi,Angelman,Williams syndrome,[116] andSYNGAP1-related intellectual disability.[117]
Research suggests that autism is associated with genes that influence neural development and connectivity. These are involved in key neuronal processes such asprotein synthesis, synaptic activity,cell adhesion, and the formation and remodeling ofsynapses, as well as the regulation of excitatory and inhibitoryneurotransmission. Studies have identified lower expression of genes linked to the inhibitory neurotransmittergamma-aminobutyric acid, alongside higher expression of genes associated withglial (e.g.,astrocytes) and immune (e.g.,microglia) cells, correlating with higher numbers of these cells in post-mortem brain tissue. Genes associated with variation in themTOR signaling pathway, which is involved in cell growth and survival, are also under investigation.[118] Some hypotheses inevolutionary psychiatry suggest that autism-associated genes may persist because of proposed links to traits such as intelligence, systematizing abilities, or innovation.[119]
If parents have one autistic child, the chance of having a second autistic child ranges from 7% to 20%.[67] Though autism is highly heritable, many autistic people have only non-autistic family members. In some cases, this may be explained byde novo structural variations—such asdeletions,duplications, orinversions—that arise spontaneously duringmeiosis and are not present in the parents' genomes.[120][121] The likelihood of being autistic is greater with older fathers than with older mothers; two potential explanations are the known increase in the number of mutations in older sperm and the hypothesis that men marry later if they carry a genetic predisposition and show some signs of autism.[122]
Research on the evolutionary advantages of autism and associated genes has suggested that autistic people may have contributed uniquely to human development, particularly in technological innovation (such as tool-making) and in detailed observation and analysis of the natural environment.[123] Systematic reviews emphasize that these ideas remain speculative and that no single evolutionary explanation has been established.[124]
Social factors
Social factors such as upbringing are not known to cause autism, but it is possible that increasing demands for flexibility and social interaction in education, or in one's personal and professional life, may cause people to exhibit pronounced difficulties that would not have led to diagnosis in a different setting.[14][15]
Neurocognitive theories
Various theoretical frameworks attempt to integrate underlying genetic and environmental causes with observed neurobiological findings and behavioral traits.
TheIntense World Theory proposes that a higher neural responsiveness in autism leads to more intense sensory perception, attention, memory, and emotional responses, shaping the person's experience.[125]
The Enhanced Perceptual Functioning model of autism posits that superior and more independent functioning of auditory and visual perception is the root cause of the specific pattern of cognitive, behavioral, and neural performance observed in autistic people.[30] The model asserts the importance of perception, arguing it is more central to the autistic phenotype than social or higher-order cognitive processes.[30]
Beyond models of causation and brain function, cognitive theories have been developed to explain patterns of information processing common in autistic people, to better understand the autistic phenotype.[126] While these cognitive accounts describe how autistic traits may manifest, they are generally viewed as explanations of the behavioral and cognitive consequences of the underlying neurobiological development rather than primary causes themselves.[126]
Theempathising–systemising theory posits that autistic people have distinct cognitive styles related to analyzing systems versus empathizing with others.[126]
Early life and prenatal or perinatal factors
Certain factors during pregnancy and birth may increase the likelihood of autism,[127] although no single factor is conclusive and study results are often inconsistent.[128] These factors include advanced parental age,[129][130] maternal health conditions (e.g.,gestational diabetes, infections such asrubella,[131] inflammation[132]), exposure to certain medications (e.g.,valproate[128]), and some environmental exposures like significantair pollution during pregnancy.[133] While many environmental factors have been investigated, few have established links,[128] and some prominent claims (e.g.,vaccines orparenting styles) have been disproven.[134]
Disproven refrigerator mother hypothesis
Work on autism in the mid-20th century proposed the "frigid mother" orrefrigerator mother hypothesis, according to which poor parenting or lack of emotional support from parents leads to autism.[135] When it was proposed, the hypothesis contributed to considerable media attention about autism, which had previously been mostly ignored.[136] The hypothesis has since fallen out of favor, and has not garnered support when studied.[135] But the blame placed on parents of children on the autism spectrum, especially mothers, has contributed to substantial stigma.[137][138]
Early social experiences, such as caregiver interactions or deprivation, may shape the development of autism, potentially viagene–environment correlations, and are distinct from the discredited refrigerator mother hypothesis.[20]
Parents may first become aware of autistic characteristics in their child around the time of a routine vaccination. This has led to theories – subsequently disproven – blamingvaccine "overload", thevaccine preservative thiomersal, or theMMR vaccine for causing autism.[139] In 1998, British physicianAndrew Wakefield led a fraudulent, litigation-funded study that suggested that theMMR vaccine may cause autism.[140][141][142][143][144] His co-authors have since recanted the claims made in the study.[145] Wakefield wasstruck off the British medical register for "serious professional misconduct" after determination that his involvement in the study amounted to fraud, leading to the loss of his right to practice medicine.[146]
Two versions of the vaccine causation hypothesis were that autism results from brain damage caused by either the MMR vaccine itself,[147] or bymercury used as a vaccine preservative.[148] No convincing scientific evidence supports these claims.[147] They are biologically implausible,[139] and further evidence continues to refute them, including the observation that the rate of autism continues to climb despite elimination ofthimerosal from most routine vaccines given to children from birth to 6 years of age.[148][149][150][151][152]
A 2014 meta-analysis examined ten major studies on autism and vaccines involving 1.25 million children worldwide; it concluded that neither the vaccine preservative thimerosal (mercury), nor the MMR vaccine, which has never contained thimerosal,[153] lead to autism.[154] Despite this, misplaced parental concern has led to lower rates ofchildhood immunizations,outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.[155][156]
Since 1980, the committees behind both manuals have aimed for greater convergence, incorporating biological research while keeping behavior-based criteria.[165][166][167][168] ICD-11 instead records whether the person has co-occurring intellectual disability or language impairment.[169]
Some researchers have questioned whether existing criteria capture the full phenomenon, prompting proposals for prototype descriptions, transdiagnostic biological markers, or distinctions between common behavioral traits and rarer genetic or environmental factors.[170] Others have proposed alternatives to the disorder-focused spectrum model that deconstruct autism into separate phenomena: a non-pathological spectrum of behavioral traits in the general population,[171] and rare genetic mutations or environmental factors influencing neurodevelopmental and psychological conditions.[171]
The DSM-5 and DSM-5-TR adopt a dimensional approach, with one diagnostic category for disorders that fall under the autism spectrum umbrella. Within that category, the DSM-5 has a framework that differentiates individuals by dimensions of symptom severity and by associated features (i.e., the presence of other conditions or factors that may contribute to the symptoms, other neurodevelopmental or mental conditions, intellectual disability, or language impairment).[1] The two core symptom domains are (a) social communication and (b) restricted, repetitive behaviors. Clinicians may specify separate severity levels for each domain based on the degree to which symptoms affect daily functioning, rather than providing a single overall severity rating.[176]
Before the fifth edition, the DSM separated social deficits and communication deficits into two domains.[177] The DSM-5 also revised the onset criteria to specify that symptoms appear in the early developmental period, noting that symptoms may manifest later when social demands exceed capabilities; the previous edition had required onset before age three.[178] These revisions remain in the DSM-5-TR.[1]
Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual's age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual's functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.
Currently, there is no cure for autism.[27] From the perspective ofneurodiversity, "curing" or otherwise treating autism may not be an appropriate goal.[180][181]
Interventions targeting specific challenges or co-occurring conditions associated with autism are widely regarded as important.[182] Perspectives on the goals of these interventions vary: themedical model of disability often focuses on addressing core characteristics such as social communication difficulties and restricted/repetitive behaviors.[183] The neurodiversity movement supports interventions aimed at enhancing functional communication (spoken or non-spoken), managing related issues likeanxiety or inertia, or addressing behaviors considered harmful, rather than seeking to alter core autistic features.[184][183]
Studies of interventions have methodological problems that prevent definitive conclusions aboutefficacy,[185] but the development of evidence-based interventions has advanced.[186] Several therapies can help autistic children,[187] and they are typically tailored to the child's needs.[188] The main goals of therapy are to lessen associated difficulties and family distress, and to increasequality of life and functional independence. In general, higherIQs correlate with higher responsiveness to interventions and larger intervention outcomes.[189][186] Behavioral, psychological, educational, and skill-building interventions may be used to help autistic people learn skills for living independently, as well as other social, communication, and language skills.[28] Therapy also aims to reduce behaviors perceived as inappropriate and to build upon strengths.[190] Medications have not been found to reduce autism's core features, but may be used for associated difficulties, such as irritability or inattention.[191]
An autistic boy works with a behavioral therapist to identify different letters of the alphabet as part of a language therapy program.
Applied behavior analysis (ABA) is a behavioral therapy that aims to teach autistic children certain social and other behaviors byprompting using rewards andreinforcement learning. This includes learning fine and gross motor and language skills through play, expressive labeling, and requesting. It also seeks to reduce aggressive and self-injurious behavior by assessing its environmental causes and reinforcing replacement behaviors. Early, intensive ABA therapy has demonstrated effectiveness in enhancing preschool children's language skills, adaptive functioning, and intellectual performance.[194][195][196][197] Another review reported a lack of adverse event monitoring, although such adverse effects may be common.[198]
Interventions for early childhood may be based on different theoretical frameworks, such as ABA (with itsstructured andnaturalistic approaches) andDevelopmental Social Pragmatic (DSP) models.[186] Research indicates that in acquiring spoken language, autistic children with higherreceptive language skills tend to make progress with fewer hours (2.5 to 20 per week) of a naturalistic approach, whereas those with lower receptive language skills tend to show more progress only with a greater intensity of intervention (25 hours per week) using discrete trial training, a structured form of ABA.[194][196]
ABA has faced criticism.[199][200][201] Sandoval-Norton et al. describe it as unethical and argue that it has unintended consequences, such as prompt dependency, susceptibility to psychological abuse, and overemphasis on compliance, which can create challenges in the transition to adulthood.[199] Increasingly, ABA is also criticized for trying to reduce or eliminate autistic behaviors to make children appear less autistic, rather than respectingneurodiversity.[202] A problem with unreportedconflicts of interest in ABA research has been described, with potential effects on the quality of evidence.[203] In response, some ABA advocates suggest that instead of discontinuing the therapy, efforts should focus on increasing protections and ethical compliance.[204]
A related type of intervention is parent training models.[186] These teach parents to implement various ABA and DSP techniques themselves. Several parent-mediated behavioral therapies target social communication difficulties, while their effect on restricted and repetitive behaviors (RRBs) is uncertain.[205] Similarly, teacher-implemented interventions that combinenaturalistic ABA with a developmental social pragmatic approach have been associated with effects on young children's social-communication behaviors, although there is limited evidence regarding effects on broader autistic characteristics.[186]
Inclusion in education and the workplace
Inclusive education models strive to support autistic students in mainstream educational settings, moving away from segregatedspecial education environments toward participation alongside their peers.[206] Despite these efforts, autistic students can face significant barriers, sometimes leading totrauma or emotionally-based school non-attendance.[206][207] This avoidance is often rooted in overwhelming sensory environments, social anxieties, communication breakdowns,bullying, or lack of adequate support and understanding, rather than defiance.[206][207]
Central to successful inclusion is the application of frameworks likeUniversal Design for Learning (UDL), which proactively designscurricula and learning environments to be accessible and engaging for all students, including those who are autistic.[208] UDL principles accommodate varied learning styles, sensory sensitivities, and communication preferences often present in autistic people.[208]
The SPACE framework (sensory, predictability, acceptance, communication, empathy) developed by Doherty et al. primarily for healthcare settings offers a lens for identifying and addressing common environmental barriers that can contribute to distress and avoidance behaviors for autistic people.[29]Accommodations may include providing quiet spaces as a retreat for people feeling overwhelmed.[209] Autistic students may also need help initiating and maintaining social relationships with their peers if they wish to do so.[206] Especially in higher education, some autistic students may need help withexecutive functioning, e.g., managing their own work, and the ability to initiate and complete tasks.[210]
Transitioning to adulthood, autistic people often encounter substantial barriers to securing and maintaining meaningful employment, leading to high rates ofunemployment andunderemployment compared to the general population.[31] Challenges can include navigating traditional interview processes,[211] difficulties with unspoken social rules in the workplace, sensory sensitivities to office environments (e.g., lighting, noise), and needs for clear, direct communication and structured tasks.[31][212] Effective workplace inclusion involves implementing reasonable adjustments such as flexible working hours or locations, providingnoise-canceling headphones, staff training, andmentorship programs.[31][212] Working from home can help to avoid overwhelming sensory or social situations, even if this means losing desirable social contact.[213][214]Autism-friendly workplaces not only allow autistic employees to utilize their unique skills and perspectives but also benefit employers through increased innovation, problem-solving capabilities, and employee loyalty.[212][215]
Pharmacological interventions
Autistic people may be prescribed medication to manage specific co-occurring conditions or behaviors, such asADHD,anxiety, aggression, or self-injurious behaviors, particularly when non-pharmacological interventions alone have been insufficient.[216][217] Medications are not routinely recommended for autism's core features, such as social and communication difficulties or restricted and repetitive behaviors.[218]
Some research suggests that risperidone and aripiprazole may also reduce restricted and repetitive behaviors, such as hand-flapping or body-rocking.[218] The evidence supporting this use has limitations, including study size and scope, alongside concerns about adverse effects.[222] A meta-analysis found no significant efficacy of these antipsychotics orSSRI antidepressants in reducing these behaviors.[223] Stimulant medications likemethylphenidate may reduce inattention or hyperactivity in some autistic children, particularly whenADHD is also present.[188] But methylphenidate's efficacy is lower in autistic people with ADHD compared to non-autistic people with ADHD, and side effects are more common.[224]
Alternative medicine
Alternative therapies have been researched and implemented, and many have resulted in harm to autistic people.[188] For example,chelation therapy is not recommended as a treatment for autism, with risks outweighing potential benefits.[225] Reports of death from botched chelation therapy as treatment for autism have been documented.[226][227] Medical authorities have condemnedbleach-based approaches, such aschlorine dioxide solutions marketed asMiracle Mineral Solution, as dangerous and ineffective.[228] The BritishNHS also warns againstCEASE therapy, which rejects vaccinations and recommends potentially harmful amounts ofdietary supplements.[229] There is also no evidence for the efficacy ofhyperbaric oxygen therapy and its use is not recommended.[230]
Although sometimes used for autistic people, no reliable evidence indicates agluten- and casein-free diet as a standard intervention.[231][232][233] Autistic children's preference for unconventional foods as well as gastrointestinal problems and lack of exercise can lead to reduction in bone cortical thickness, and this risk is greater in those on casein-free diets, as a consequence of the low intake ofcalcium andvitamin D.[234]
Emerging evidence-based interventions
Interventions for autistic adults have limited evidence; cognitive behavioral approaches andmindfulness are considered promising.[235]Music therapy for autistic people likely improves overall autism severity, global functioning, and quality of life, but evidence is unclear for social and communication skills.[236]Animal-assisted activities and therapies show promise in improving social communication, irritability, hyperactivity, and word usage in autistic people.[237]
Caregivers
Families who care for an autistic child often experience greater stress.[238] Parents may struggle to understand their child and to find appropriate care options.[medical citation needed] Affiliatestigma can also reduce quality of life, where negative attitudes toward the autistic child are extended to those close to them.[239] Family members who are themselves autistic may be better able to understand the autistic child.[62]
Autism typically persists whether diagnosed in children or in adults, but those who no longer meet the criteria for diagnosis may have it removed.[6] Some report that those with limited support needs are likely to have lessened autistic features over time,[240] while others argue that this perception is likely due tomasking; i.e., hiding autistic characteristics to avoid stigma.[241] About 85% of autistic people need support with independent living in adulthood.[242] Factors such as developing spoken language before age six, having anIQ above 50, and possessing marketable skills are associated with a higher likelihood of independent living in adulthood.[243]
Risk factors for self-harm andsuicidality include circumstances that could affect anyone but are more common among autistic people, such asmental health problems (e.g.,anxiety disorder) and social problems (e.g.,unemployment andsocial isolation). In addition, there are autism-specific factors, such as exhausting attempts to behave like a non-autistic person to avoid stigma and negative reactions of society towards autistic people (masking).[244] Autistic people are also at significantly increased risk of victimization, including bullying, sexual assault, and other forms of criminal abuse.[245] A 2019 meta-analysis found autistic people to be four times more likely to have depression than non-autistic people.[246]
Rates of suicidality vary significantly depending upon what is being measured.[244] This is partly because questionnaires developed for non-autistic subjects are not always valid for autistic people.[244] As of 2023, the Suicidal Behaviours Questionnaire–Autism Spectrum Conditions (SBQ-ASC) is the only testvalidated for autistic people.[244] According to some estimates, about a quarter of autistic youth[247] and a third of all autistic people[244][248] have experiencedsuicidal ideation at some point. Autistic people are about three times as likely as non-autistic people to make asuicide attempt.[77][249] Almost 10% of autistic youth[247] and 15% to 25% of autistic adults[244][248] have attempted suicide. Rates of suicide attempts and suicidal ideation are the same for people formally diagnosed with autism and people who have typical intelligence and are believed to be autistic but have not been diagnosed.[244] The suicide risk is higher for autistic people who are notcisgender males and do not haveintellectual disabilities.[244][249]
Several conditions can co-occur with autism at a higher rate than in the rest of the population.[253] This may be referred to ascomorbidity, and may increase with age, causing difficulties for youth on the autism spectrum, and can make interventions and therapies more challenging. Features of autism and other diagnoses often overlap, and autism's characteristics can make traditional diagnostic procedures more difficult.[254][255] This is sometimes known asdiagnostic overshadowing.[256] Common co-occurring conditions are:
ADHD is seen in between 25% to 32% of autistic people.[257] Characteristics similar to those of ADHD can be part of an autism diagnosis.[258]
Epilepsy occurs in about 10% of autistic people.[259] The risk is higher for older autistic people and those with intellectual disability.[260]
Intellectual disabilities are some of the most common co-occurring conditions with autism (30% to 40%).[261] As autism diagnosis is increasingly given to people with lower support needs, there is a tendency for the proportion with co-occurring intellectual disability to decrease over time.
Variousanxiety disorders can co-occur with autism, with overall co-occurring rates of 17% to 23%.[257] Many anxiety disorders have characteristics better explained by autism itself, or are hard to distinguish from autism's features.[262]
Rates of co-occurringdepression in autistic people range from 9% to 13%.[257]
Starting in adolescence, some autistic people fall under the criteria for the similar-lookingschizoid personality disorder, which is characterized by alack of interest in social relationships, a tendency toward a solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy.[263]
Gastrointestinal problems are among the most commonly reported co-occurring medical conditions in autistic people, and occur at higher rates than in the general population.[265][266] Frequently reported issues include chronic constipation, diarrhea, abdominal pain, gastroesophageal reflux, and functional gastrointestinal disorders.[267] Gastrointestinal symptoms in autistic people have been associated with increased irritability, distress, sleep disturbances, and challenges in communication, particularly in children who have limited spoken language.[265][268][269][270] The underlying mechanisms are not fully understood and are likely multifactorial, involving interactions between diet, gut motility, sensory sensitivities, stress responses, and the gut-brain axis.[271][267]
Sleep problems affect about two-thirds of autistic people at some point in childhood. These most commonly include symptoms ofinsomnia, such as difficulty falling asleep, frequentnocturnal awakenings, and early-morning awakenings. Sleep problems are associated with difficult behaviors and family stress, and are often a focus of clinical attention over and above the autism diagnosis.[272]
The World Health Organization notes that reports on prevalence vary widely. It estimates that about 1 in 127 children were autistic between 2012 and 2021 with a trend of increasing prevalence over time. This may reflect an underestimate of prevalence inlow- andmiddle-income countries.[2][3] Surveillance studies in community samples of adults suggest a similar share of the adult population would meet diagnostic criteria if formally assessed.[16] The number of people diagnosed has increased since the 1990s, likely due to a combination of increased recognition of autism, better availability of diagnosis, and changes to the diagnostic criteria.[2] The increase in autism is largely attributable to changes in diagnostic practices, referral patterns, availability of services, age at diagnosis, and public awareness,[277][278][279] particularly among women,[280] though other unidentified environmental factors may exist.[281]
TheCenters for Disease Control's Autism and Developmental Disabilities Monitoring Network reported that approximately 1 in 31 children in the United States is diagnosed with autism, based on data collected in 2022.[282] For 2016 data, the estimate was 1 in 54, compared to 1 in 68 in 2010 and 1 in 150 in 2000.[282] Diagnostic criteria for autism have changed significantly since the 1980s; for example,U.S. special-education autism classification was introduced in 1994.[283]
Sex ratio
Males are about three times more likely to be diagnosed with autism than females.[22]Several theories about the higher prevalence in males have been investigated.[284] Prevalence differences may be mainly due to a result of differences in expression of characteristics between males and females, withautistic women and girls showing less atypical behaviors and therefore being less likely to be diagnosed with autism.[285]
In 1911, Swiss psychiatristPaul Eugen Bleulercoined the German termAutismus to characterize the social withdrawal he observed in people withschizophrenia.[286] Rendered in English asautism, the term derives from the Greek wordautos ("self").[287] Bleuler used the term for a symptom of adult schizophrenia: a person's retreat from reality into their own subjective world. He also mentioned "autistic thinking" as a fleeting, illogical thought process everyone experiences. In the mid-1920s, German psychiatristFritz Künkel categorized over 100 schizophrenic patients into four groups, one of which he labeled "autistic", highlighting disturbances in emotional life. In 1926, building on his work and Bleuler's,Grunya Sukhareva published an article about six boys who were musically gifted and had a tendency toward abstract thinking. She called their affects "flattened" and their tendency to avoid other children an "autistic attitude".[288] Scholars have credited Sukhareva with making observations that closely mirror ASD as described by theDSM-5 andICD-11.[289] Her work expanded on the definition throughout her career while making great strides in differentiating ASD and schizophrenia nearly 30 years before the establishment of separate classifications for these diagnoses with the 1980 publication of theDSM-III.[290]
Focused interests are commonly found in autistic people and can include activism. Environmental activistGreta Thunberg has spoken favorably about her autism diagnosis, saying that autism can be a source oflife purpose, as well as the basis of careers, hobbies, and friendships.[302][303][291] Entrepreneur and co-founder ofMicrosoftBill Gates has written, "If I were growing up today, I probably would be diagnosed on the autism spectrum."[304]
Legal implications of diagnosis
In Sweden, people with an autism diagnosis are required to provide additional proof of suitability to apply for a driver's license[305] and may facebarriers to entering military service.[306]
In the United Kingdom, an autistic police officer was rejected from firearms training, which a tribunal later ruled was illegal discrimination.[307]
In the United States, autism is generally a "disqualifying condition" for joining the military, but autistic people can apply for a medical waiver.[308]
Autistic people may facediscrimination of various kinds, both directly and indirectly, in a variety of settings, professional, educational, or clinical.[309] Such discrimination is often initiated after other people identify the autistic person as different from themselves, which may occur very quickly.[309] This discrimination sometimes leads toviolence,assault, orsocial exclusion.[309] Various legal limitations on people with an autism diagnosis have also been considered discriminatory.[305][307]
Neurodiversity movement
The neurodiversity movement has many symbols, but is often represented by theinfinity symbol.
Some autistic people and affiliated researchers[310] have advocated a shift in attitudes toward the view that autism is a difference, rather than a disease that ought to be treated or cured.[311][312][313] Critics have bemoaned the entrenchment of some of these groups' opinions, and that they speak to a select group of autistic people with limited difficulties.[294][314][296][315][316] Clinical and policy guidance in Australia, the United States, and the United Kingdom now promoteneurodiversity-affirming language—for example, using "characteristics" instead of "symptoms" and avoiding words such as "cure".[317][180][318]
The neurodiversity movement and theautism rights movement aresocial movements within the context ofdisability rights, emphasizing the concept ofneurodiversity, which describes the autism spectrum as a result of healthy and valuable variations in thehuman brain rather than a disorder to be cured.[294][319] The autism rights movement advocates including greater acceptance of autistic behaviors, therapies that focus on coping skills rather thanimitating the behaviors of non-autistic people,[320] and the recognition of the autistic community as aminority group.[320][316] Autism rights or neurodiversity advocates believe that the autism spectrum is genetic and should be accepted as a healthy variation in thehuman genome.[294] These movements are not without detractors. A common argument against neurodiversity activists is that most have relatively low support needs, or areself-diagnosed, and do not represent the views of autistic people with higher support needs.[316][321][322] The argument has been made that only autistic people with lower support needs should be included under the neurodiversity banner, as autism with high support needs "may rightfully be viewed as a disability".[316] The concept of neurodiversity is contentious in autism advocacy and research groups and has led to infighting.[314][296]
^abSteinhausen HC, Mohr Jensen C, Lauritsen MB (13 January 2016). "A systematic review and meta-analysis of the long-term overall outcome of autism spectrum disorders in adolescence and adulthood".Acta Psychiatrica Scandinavica.133 (6):445–452.doi:10.1111/acps.12559.PMID26763353.
^abLoomes R, Hull L, Mandy WP (1 June 2017). "What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis".Journal of the American Academy of Child & Adolescent Psychiatry.56 (6):466–474.doi:10.1016/j.jaac.2017.03.013.PMID28545751.
^Bertelli MO, Azeem MW, Underwood L, Scattoni ML, Persico AM, Ricciardello A, Sappok T, Bergmann T, Keller R, Bianco A, Corti S, Miselli G, Lassi S, Croce L, Bradley E, Munir K (2022)."Autism Spectrum Disorder".Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder. pp. 369–455.doi:10.1007/978-3-319-95720-3_16.ISBN978-3-319-95719-7. p. 391:Persons with autism spectrum disorder and/or other neurodevelopmental problems are more likely than the general population to havetransgender identity,non-heterosexual sexual orientation, and othergender non-conformities.
^Graham Holmes L, Ames JL, Massolo ML, Nunez DM, Croen LA (1 April 2022). "Improving the Sexual and Reproductive Health and Health Care of Autistic People".Pediatrics.149 (Supplement 4).American Academy of Pediatrics: e2020049437J.doi:10.1542/peds.2020-049437J.PMID35363286.A substantial proportion of autistic adolescents and adults are LGBTQIA+. Autistic people are more likely to be transgender or gender nonconforming compared with non-autistic people, and findings from a recent autism registry study suggest that among autistic people able to self-report on a survey, up to 18% of men and 43% of women may be sexual minorities.
^abcMukerji C, Mottron L, McPartland JC (2013), "Enhanced Perceptual Functioning", in Volkmar FR (ed.),Encyclopedia of Autism Spectrum Disorders, New York, NY: Springer, pp. 1117–1118,doi:10.1007/978-1-4419-1698-3_723,ISBN978-1-4419-1698-3
^Rodríguez Mega E (10 May 2023). "'I am not a broken version of normal' — autistic people argue for a stronger voice in research".Nature.617 (7960):238–241.doi:10.1038/d41586-023-01549-1.PMID37165246.
^Murray D (2021), "Monotropism: An Interest-Based Account of Autism", in Volkmar FR (ed.),Encyclopedia of Autism Spectrum Disorders, Cham: Springer International Publishing, pp. 2954–2956,doi:10.1007/978-3-319-91280-6_102269,ISBN978-3-319-91280-6
^abFusaroli R, Lambrechts A, Bang D, Bowler DM, Gaigg SB (March 2017). "Is voice a marker for Autism spectrum disorder? A systematic review and meta-analysis".Autism Research.10 (3):384–407.doi:10.1002/aur.1678.PMID27501063.
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^Yew RY, Samuel P, Hooley M, Mesibov GB, Stokes MA (2021). "A systematic review of romantic relationship initiation and maintenance factors in autism".Personal Relationships.28 (4):777–802.doi:10.1111/pere.12397.
^abCook J, Hull L, Crane L, Mandy W (1 November 2021). "Camouflaging in autism: A systematic review".Clinical Psychology Review.89 102080.doi:10.1016/j.cpr.2021.102080.PMID34563942.
^DSM-5-TR, "Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)".
^abcdAndersen AM, Lipkin PH, Law JK (2021). "Elopement". In Volkmar FR (ed.).Encyclopedia of Autism Spectrum Disorders (2nd ed.). Cham: Springer International Publishing AG.ISBN978-3-319-91280-6.
^abFilipek PA, Accardo PJ, Baranek GT, Cook EH, Dawson G, Gordon B, et al. (December 1999). "The screening and diagnosis of autistic spectrum disorders".Journal of Autism and Developmental Disorders.29 (6):439–484.doi:10.1023/A:1021943802493.PMID10638459. This paper represents a consensus of representatives from nine professional and four parent organizations in the US.
^Fournier KA, Hass CJ, Naik SK, Lodha N, Cauraugh JH (October 2010). "Motor coordination in autism spectrum disorders: a synthesis and meta-analysis".Journal of Autism and Developmental Disorders.40 (10):1227–1240.doi:10.1007/s10803-010-0981-3.PMID20195737.
^Murray A, Koronczai B, Király O, Griffiths MD, Mannion A, Leader G, Demetrovics Z (2021). "Autism, Problematic Internet Use and Gaming Disorder: A Systematic Review".Review Journal of Autism and Developmental Disorders.9. Springer:120–140.doi:10.1007/s40489-021-00243-0.hdl:10379/16762.
^MacOun SJ, Bedir B, Sheehan J (2022). "Autism across the Ages: An Abbreviated History".Handbook of Autism and Pervasive Developmental Disorder. Autism and Child Psychopathology Series. pp. 3–28.doi:10.1007/978-3-030-88538-0_1.ISBN978-3-030-88537-3.OCLC1341298051. p. 18:To date no one genetic feature or environmental cause has proven etiological in explaining most cases autism or has been able to account for rising rates of autism.
^Sauer AK, Stanton JE, Hans S, Grabrucker AM (2021). "Autism Spectrum Disorders: Etiology and Pathology". Written at Brisbane, Australia. In Grabrucker AM (ed.).Autism spectrum disorders. Andreas M. Grabrucker. Brisbane: Exon Publications (published 20 August 2021). pp. 1–16.doi:10.36255/exonpublications.autismspectrumdisorders.2021.etiology.ISBN978-0-6450017-8-5.OCLC1280592589.PMID34495611.The cause of ASD is unknown, but several genetic and non-genetic risk factors have been characterized that, alone or in combination, are implicated in the development of ASD.
^abHappé F, Ronald A (December 2008). "The 'fractionable autism triad': a review of evidence from behavioural, genetic, cognitive and neural research".Neuropsychology Review.18 (4):287–304.doi:10.1007/s11065-008-9076-8.PMID18956240.
^abHappé F, Ronald A, Plomin R (October 2006). "Time to give up on a single explanation for autism".Nature Neuroscience.9 (10):1218–1220.doi:10.1038/nn1770.PMID17001340.
^Goh S, Thiyagarajan L, Dudding-Byth T, Pinese M, Kirk EP (1 January 2025). "A systematic review and pooled analysis of penetrance estimates of copy-number variants associated with neurodevelopment".Genetics in Medicine.27 (1) 101227.doi:10.1016/j.gim.2024.101227.PMID39092588.
^Woodbury-Smith M, Scherer SW (2018). "Progress in the genetics of autism spectrum disorder".Developmental Medicine & Child Neurology.60 (5):445–451.doi:10.1111/dmcn.13717.PMID29574884.
^abcdFletcher-Watson S, Happé F (2019).Autism: A New Introduction to Psychological Theory and Current Debate (2nd ed.). Milton: Taylor & Francis Group.ISBN978-1-138-10612-3.
^Vohr BR, Poggi Davis E, Wanke CA, Krebs NF (April 2017). "Neurodevelopment: The Impact of Nutrition and Inflammation During Preconception and Pregnancy in Low-Resource Settings".Pediatrics (Review).139 (Suppl 1):S38–S49.doi:10.1542/peds.2016-2828F.PMID28562247.
^abGyawali S, Patra BN (February 2019). "Trends in concept and nosology of autism spectrum disorder: A review".Asian Journal of Psychiatry.40:92–99.doi:10.1016/j.ajp.2019.01.021.PMID30776666.
^Cleary M, West S, Mclean L (1 September 2022). "From 'Refrigerator Mothers' to Empowered Advocates: The Evolution of the Autism Parent".Issues in Mental Health Nursing.44 (1):64–70.doi:10.1080/01612840.2022.2115594.PMID36049183.
^Taylor LE, Swerdfeger AL, Eslick GD (June 2014). "Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies".Vaccine.32 (29):3623–3629.doi:10.1016/j.vaccine.2014.04.085.PMID24814559.
^Sturmey P, Dalfern S (1 December 2014). "The Effects of DSM5 Autism Diagnostic Criteria on Number of Individuals Diagnosed with Autism Spectrum Disorders: A Systematic Review".Review Journal of Autism and Developmental Disorders.1 (4):249–252.doi:10.1007/s40489-014-0016-7.
^Mezzich JE (2002). "International surveys on the use of ICD-10 and related diagnostic systems".Psychopathology.35 (2–3):72–75.doi:10.1159/000065122.PMID12145487.
^abLai MC, Lombardo MV, Chakrabarti B, Baron-Cohen S (23 April 2013)."Subgrouping the Autism 'Spectrum': Reflections on DSM-5".PLOS Biology.11 (4) e1001544.doi:10.1371/journal.pbio.1001544.PMC3635864.PMID23630456.New in DSM-5 is the explicit recognition of the "spectrum" nature of autism, subsuming and replacing the DSM-IV Pervasive Developmental Disorder (PDD) categorical subgroups of "autistic disorder," "Asperger's disorder," "pervasive developmental disorder not otherwise specified," and "childhood disintegrative disorder" into a single umbrella term "Autism Spectrum Disorder" (ASD).
^DSM-5-TR, "Autism spectrum disorder encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner's autism,high-functioning autism,atypical autism, pervasive developmental disorder not otherwise specified, childhood disintegrative disorder, and Asperger's disorder".
^DSM-5-TR, "It may be helpful to note level of support needed for each of the two core psychopathological domains in Table 2 (e.g., 'requiring very substantial support for deficits in social communication and requiring substantial support for restricted, repetitive behaviors')".
^abcJi N, Findling RL (March 2015). "An update on pharmacotherapy for autism spectrum disorder in children and adolescents".Current Opinion in Psychiatry.28 (2):91–101.doi:10.1097/YCO.0000000000000132.PMID25602248.
^Langh U, Perry A, Eikeseth S, Bolte S (November 2021). "Quality of early intensive behavioral intervention as a predictor of children's outcome".Behavior Modification.45 (6):911–928.doi:10.1177/0145445520923998.PMID32436396.
^Kirkham P (1 April 2017). "'The line between intervention and abuse' – autism and applied behaviour analysis".History of the Human Sciences.30 (2):107–126.doi:10.1177/0952695117702571.
^Gorycki KA, Ruppel PR, Zane T (31 December 2020). Navalta CP (ed.). "Is long-term ABA therapy abusive: A response to Sandoval-Norton and Shkedy".Cogent Psychology.7 (1) 1823615.doi:10.1080/23311908.2020.1823615.hdl:1808/31691.
^Harrop C (August 2015). "Evidence-based, parent-mediated interventions for young children with autism spectrum disorder: The case of restricted and repetitive behaviors".Autism.19 (6):662–72.doi:10.1177/1362361314545685.PMID25186943.
^abcSmith T (2021). Kirby A (ed.).Neurodiversity at work: drive innovation, performance and productivity with a neurodiverse workforce. London, United Kingdom New York, NY New Delhi: Kogan Page.ISBN978-1-3986-0026-3.
^Dunne M (2024).The Neurodiversity Edge: The Essential Guide to Embracing Autism, ADHD, Dyslexia, and Other Neurological Differences for Any Organization (1st ed.). Newark:John Wiley & Sons.ISBN978-1-394-19928-0.
^Sanchack KE, Thomas CA (December 2016). "Autism Spectrum Disorder: Primary Care Principles".American Family Physician.94 (12):972–979.PMID28075089.
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^Ameis SH, Kassee C, Corbett-Dick P, Cole L, Dadhwal S, Lai MC, et al. (November 2018). "Systematic review and guide to management of core and psychiatric symptoms in youth with autism".Acta Psychiatrica Scandinavica.138 (5):379–400.doi:10.1111/acps.12918.PMID29904907.
^King BH, Rynkiewicz A, Janas-Kozik M, Tyszkiewicz-Nwafor M (2020). "Medications to Treat Co-Occurring Psychiatric Conditions in Autism Spectrum Disorder". In White SW, Maddox BB, Mazefsky CA (eds.).The Oxford handbook of autism and co-occurring psychiatric conditions. Oxford library of psychology. New York, NY: Oxford University Press. pp. 371–387.ISBN978-0-19-091076-1.
^Gogou M, Kolios G (June 2018). "Are therapeutic diets an emerging additional choice in autism spectrum disorder management?".World Journal of Pediatrics (Review).14 (3):215–223.doi:10.1007/s12519-018-0164-4.PMID29846886.Current literature knowledge provides evidence that ketogenic and casein/gluten-free diet may have their own place in our reserve for the therapeutic management of specific subsets of children with autism. ... More clinical studies about the effect of gluten/caseinfree diet in these patients are available. However, available data arise from studies with small sample size and are still controversial. In general, despite encouraging data, no definite proof still exists. Under this view, the use of therapeutic diets in children with autism should be restricted to specific subgroups, such as children with autism and epilepsy or specific inborn errors of metabolism(ketogenic diet), children with known food intolerance/allergy or even children with food intolerance markers (gluten- and casein-free diet). Their implementation should always be guided by health care practitioners.
^Marí-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-González A, Morales-Suárez-Varela M (December 2014). "Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review".Journal of Child Neurology.29 (12):1718–1727.doi:10.1177/0883073814531330.hdl:10171/37087.PMID24789114.
^Kapp SK, Ne'eman A (2020), Kapp SK (ed.), "Lobbying Autism's Diagnostic Revision in the DSM-5",Autistic Community and the Neurodiversity Movement: Stories from the Frontline, Singapore: Springer, pp. 167–194,doi:10.1007/978-981-13-8437-0_13,ISBN978-981-13-8437-0{{citation}}: CS1 maint: work parameter with ISBN (link)
^Graham Holmes L, Ames JL, Massolo ML, Nunez DM, Croen LA (1 April 2022). "Improving the Sexual and Reproductive Health and Health Care of Autistic People".Pediatrics.149 (Supplement 4): e2020049437J.doi:10.1542/peds.2020-049437J.PMID35363286.
^Helverschou SB, Bakken TL, Martinsen H (2011). "Psychiatric Disorders in People with Autism Spectrum Disorders: Phenomenology and Recognition".International Handbook of Autism and Pervasive Developmental Disorders. pp. 53–74.doi:10.1007/978-1-4419-8065-6_5.ISBN978-1-4419-8064-9.OCLC746203105.
^White SW (2020).The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions. Oxford Library of Psychology Series. Brenna Maddox, Carla Mazefsky (1st ed.). Oxford: Oxford University Press, Incorporated. p. 8.ISBN978-0-19-091076-1.
^abcdLai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, Szatmari P, Ameis SH (1 October 2019). "Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis".The Lancet Psychiatry.6 (10):819–829.doi:10.1016/S2215-0366(19)30289-5.PMID31447415.
^Liu X, Sun X, Sun C, Zou M, Chen Y, Huang J, Wu L, Chen WX (2022). "Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis".Autism: The International Journal of Research and Practice.26 (1):33–50.doi:10.1177/13623613211045029.PMID34510916.
^Sala G, Hooley M, Attwood T (2019). "Autism and Intellectual Disability: A Systematic Review of Sexuality and Relationship Education".Sexuality and Disability.37 (3):353–382.doi:10.1007/s11195-019-09577-4.
^Yasuda Y, Matsumoto J, Miura K, Hasegawa N, Hashimoto R (2023). "Genetics of autism spectrum disorders and future direction".Journal of Human Genetics.68 (3):193–197.doi:10.1038/s10038-022-01076-3.PMID36038624.
^Baeza-Velasco C, Vergne J, Poli M, Kalisch L, Calati R (1 August 2025). "Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers–Danlos syndromes: A systematic review and prevalence meta-analyses".Autism.29 (8):1939–1958.doi:10.1177/13623613251328059.PMID40145613.
^Wing L, Potter D (2002). "The epidemiology of autistic spectrum disorders: is the prevalence rising?".Developmental Disabilities Research Reviews.8 (3):151–161.doi:10.1002/mrdd.10029.PMID12216059.
^Fletcher-Watson S, Happé F (2019).Autism: A New Introduction to Psychological Theory and Current Debate (2nd ed.). Milton: Taylor & Francis Group. p. 42.ISBN978-1-138-10612-3.
^"Autism | Definition, Symptoms, Neuropathology, & Diagnosis | Britannica".www.britannica.com. 21 June 2025. Retrieved4 July 2025.The term autism (from the Greek autos, meaning "self") was coined in 1911 by Swiss psychiatrist Eugen Bleuler, who used it to describe withdrawal into one's inner world, a phenomenon he observed in individuals with schizophrenia.
^Simmonds C (2019).G. E. Sukhareva's place in the history of autism research: Context, reception, translation (Thesis).doi:10.26686/wgtn.17136701.[page needed]
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^Baron-Cohen S (August 2002). "Is Asperger Syndrome Necessarily Viewed as a Disability?".Focus on Autism and Other Developmental Disabilities.17 (3):186–191.doi:10.1177/10883576020170030801.
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